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CC March 2017 Beta Blockers and Heart Failure

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echoecho's version from 2018-04-09 14:14

Section

Question Answer
The understanding of the pathophysiology of HF has evolved from a simple mechanical pump dysfunction model to a more complex ______ process?neurochemical
Beta-blockers, wich were once thought to inhibit _____ function, now are an integral part of HF therapy?systolic
*** One of the beta-blockers (name the three) should be used in patients with current or previous symptoms of heart failure with reduced ejection fraction, as they have been shown to reduce mortality in these patients?1) carvedilol (Coreg) 2) metoprolol succinate (Toprol-XL) 3) bisoprolol (Zebeta)
Although beta-blockers have not been tested in pts with New York Heart Association ( NYHA) class I HF (asymptomatic patients), they may have a role in these patients, why?since many also suffer from ischemic heart disease
What are the contraindications to the use of beta-blockers?1) heart block 2) bradycardia 3) severe obList the structive lung disease
Since studies have only shown benefits at specific levels (name the dosages for the three beta-blockers), patients should be started on low-dose beta-blockers and titrated to these target doses?1) carvedilol 25 mg BID 2) metoprolol succinate 200 mg daily 3) bisoprolol 10 mg daily
What beta-blocker has been shown to have beneficial effects for elderly patients with HF, however, it is not recommended by the American College of Cardiology Foundation/American Heart Association guidelines, as it did not reduce mortality alone?Nebivolol (Bystolic)
Comment on Propranolol (Inderal)?has modest benefits in symptomatic HF, but its impact on mortality is unclear, and it has been replaced by 2nd and 3rd generation beta-blockers in patients with HF.
Has Nadolol (Corgard) been investigated in HF?no
In patients with HF with preserved EF (previously referred to as ______ ______), the data on the benefits of beta-blockers are not as robust?diastolic dysfunction
A randomized, controlled trial of nebivolol in older patients with HF showed reductions in what?All-cause mortality and hospitalization rates (with similar benefits in pts w/ both reduced and preserved EF)
*** The American College of Cardiology recommends that patients with symptomatic HF with preserved EF and HTN, ____ ____ may be considered?beta-blockers
As in patients with HF with reduced EF, should be beta-blockers be started in patients during acute exacerbations?no
*** SUMMARY = True or false. Some beta-blockers have been shown to reduce mortality in patients with heart failure / reduced EF?true
*** SUMMARY = Beta-blockers should be introduced at a ____ dose and titrated to _____ doses after patients are stable?low; target
*** SUMMARY = Should beta-blocker therapy be started in acute exacerbations of heart failure?no
*** SUMMARY = List 3 contraindications for beta-blocker use in heart failure?1) heart block 2) bradycardia 3) severe COPD
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